Pain as an emergent issue in thalassemia

Abstract

Thalassemia is a congenital blood disorder often requiring chronic blood transfusions and iron chelation therapy [1,2]. While advances in treatment have resulted in increased life expectancy [3], extended life spans have exposed previously unidentified issues, including bodily pain. The aim of this study was to examine the prevalence, severity, predictors, and effects of pain in 265 adults/adolescents and 103 children with thalassemia. Overall, 69% of adults/adolescents reported bodily pain on the SF-36v2 health survey, with 28% reporting at least moderate pain. Parents reported pain in 56% of children using the PF-28 child health questionnaire, with only 11% reporting pain fairly often. There were no significant differences in pain in children with thalassemia compared with the general population. In adults/adolescents, pain increased significantly with age (P = 0.005), more so than in the general population. This study highlights the fact that children and young adults with thalassemia experience pain comparable to the general population, whereas older adults (aged 35+) experience greater pain. Our findings show that increased pain is associated with decreased quality of life and increased anxiety and depression.

Pain in thalassaemia: the effects of age on pain frequency and severity

“…Pakbaz et al (2005) reported moderate pain in 21% of both transfusion-dependent (N = 29) and transfusion-independent (N = 19) thalassaemia patients (aged 14Á6 AE 7Á5 years), with severe pain in 14% of transfusion-dependent and 5% of transfusion-independent patients. An analysis of SF-36 Quality of Life data, collected as part of the Thalassaemia Longitudinal Cohort (TLC), revealed a significant relationship between increasing age and pain (Trachtenberg et al, 2010). This study also found a trend between low bone mass and bodily pain reports, but it did not reach significance (Trachtenberg et al, 2010).…”

“…An analysis of SF-36 Quality of Life data, collected as part of the Thalassaemia Longitudinal Cohort (TLC), revealed a significant relationship between increasing age and pain (Trachtenberg et al, 2010). This study also found a trend between low bone mass and bodily pain reports, but it did not reach significance (Trachtenberg et al, 2010). An assessment of the relationship between bone and joint pain in 361 thalassaemia patients found no association between pain reports, bone mass and fractures (Vogiatzi et al, 2009).…”

“…There are a limited number of studies of pain in thalassaemia (Finsterbush et al, 1985;Pakbaz et al, 2005;Scalone et al, 2008;Vogiatzi et al, 2009;Trachtenberg et al, 2010) and no studies to date have been designed specifically to assess the prevalence and characteristics of pain in this population. Scalone et al (2008) identified 62% of thalassaemia patients on chelation reporting pain, although only 1% reported extreme pain.…”

Guidelines for the Standard Monitoring of Patients With Thalassemia

“…Parents reported pain in 56% of children and that pain occurred fairly often in 11% [40]. Pain was localized to the back (24%), knees (15%), head/neck (10%), large bones (8%) and small bones/ribs (5%).…”

“…Pain was found to increase with age, diverging most sharply from U.S. age-matched normal values at age 35 years. Pain is also associated with increased anxiety and depression and with a decrease in quality of life observed in patients with thalassemia as they age [40]. …”